Cooper G J, Underwood M J, Deverall P B
Department of Cardiothoracic Surgery, Guy's Hospital, London.
Br J Clin Pract. 1996 Apr-May;50(3):144-50.
The long-term benefit of myocardial revascularisation depends largely upon the continued patency of bypass grafts, but the long-term patency of vein grafts is poor. To improve the results of myocardial revascularisation, either measures to increase the patency of saphenous vein grafts or alternative conduits are required. Use of the left internal mammary artery as a graft is known to increase survival, and this has prompted wider use of other arterial grafts in the expectation that they will further enhance the long-term results of coronary artery bypass. This policy is based upon sound theory, but convincing evidence that it improves survival is lacking. Meanwhile, advances in the understanding of the pathology of vein graft occlusion have given rise to new methods of increasing vein graft patency. While these techniques are, as yet, only experimental, if translated into clinical practice, the places of arterial and venous grafts may require further assessment.
心肌血运重建的长期益处很大程度上取决于旁路移植血管的持续通畅，但静脉移植血管的长期通畅情况较差。为改善心肌血运重建的效果，要么采取措施提高大隐静脉移植血管的通畅率，要么采用替代管道。已知使用左乳内动脉作为移植血管可提高生存率，这促使人们更广泛地使用其他动脉移植血管，期望它们能进一步改善冠状动脉旁路移植的长期效果。这一策略有坚实的理论基础，但缺乏能证明其可提高生存率的确凿证据。与此同时，对静脉移植血管闭塞病理的深入理解催生了提高静脉移植血管通畅率的新方法。虽然这些技术目前仅处于实验阶段，但如果转化为临床实践，动脉和静脉移植血管的地位可能需要进一步评估。
